NHS South Worcestershire CLINICAL COMMISSIONING GROUP CONSTITUTION. Version: 1

NHS South Worcestershire CLINICAL COMMISSIONING GROUP CONSTITUTION Version: 1 NHS Commissioning Board Effective Date: 01/04/2018

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CONTENTS Part Description Page Foreword 3 1 Introduction and Commencement 4 1.1 Name 4 1.2 Statutory framework 4 1.3 Status of this constitution 4 1.4 Amendment and variation of this constitution 5 2 Area Covered 5 3 Membership 8 3.1 Membership of the Clinical Commissioning Group 8 3.2 Eligibility 11 4 Mission, Values and Aims 11 4.1 Mission 11 4.2 Values 11 4.3 Aims 12 4.4 Principles of good governance 12 4.5 Accountability 12 5 Functions and General Duties 13 5.1 Functions 13 5.2 General duties 14 5.3 General financial duties 17 5.4 Other relevant regulations, directions and documents 18 6 Decision Making: The Governing Structure 19 6.1 Authority to act 19 6.2 Scheme of reservation and delegation 19 6.3 General 19 6.4 Clinical Commissioning Group Practice Forum 20 6.5 Joint arrangements 21 6.6 The Governing Body 26 6.7 Composition of the Governing Body 28 6.8 Transparency 32 7 Roles and Responsibilities 32 7.1 Practice representatives 32 7.2 All members of the group s Governing Body 33 7.3 The chair of the Governing Body 33 7.4 The vice chair of the Governing Body 34 7.5 Governing Body GP s 34 7.6 Role of the accountable officer 34 1

Part Description Page 7.7 Role of the chief finance officer 35 7.8 Role of the Registered Nurse 36 7.9 Role of the Secondary Care Specialist Doctor 36 7.10 Role of Lay Members 37 7.11 Role of the Strategic Clinical Lead 38 7.12 Role of the Chief Operating Officer 38 7.13 Joint appointments with other organisations 39 8 Standards of Business Conduct and Managing Conflicts of Interest 41 8.1 Standards of business conduct 41 8.2 Conflicts of interest 41 8.3 Declaring and registering interests 42 8.4 Managing conflicts of interest: general 43 8.5 Managing conflicts of interest: contractors and people who 46 provide services to the group 8.6 Transparency in procuring services 46 9 The Group as Employer 47 10 Transparency, Ways of Working and Standing Orders 48 10.1 General 48 10.2 Standing orders 48 Appendix Description Page A Definitions of Key Descriptions used in this Constitution B List of Member Practices C Standing Orders C Terms of Reference Annex 1 D Scheme of Reservation and Delegation E Prime Financial Policies F The Nolan Principles G The Seven Key Principles of the NHS Constitution 2

FOREWORD a) The task of Clinical Commissioning Groups is to deliver a sustainable healthcare system in the face of the most significant financial challenge in generations, whilst maintaining quality, amidst a changing organisational environment. Medical advances offer increasing opportunities to treat disease but the cost of these advances together with an ageing population will prove very challenging and will require careful planning. In order to succeed, Commissioners will need to carefully consider efficiencies and productivity opportunities across the whole healthcare system from primary to secondary care, and work in partnership with other key clinicians, social services and patient representatives to integrate services and redesign pathways b) This constitution sets out the arrangements to meet NHS South Worcestershire Clinical Commissioning Group s responsibilities for commissioning a wide range of healthcare services for the people of South Worcestershire. c) With the commitment from the GPs within the Group and the strong relationships we already have with our stakeholders we are confident we will be in a position to deliver our vision. However, we also recognise the need to keep our attention on the day job and to manage changes to ensure they are as seamless for our patients and partners as possible. We are committed to ensuring that the quality of patient care does not suffer as a consequence of any organisational changes. d) The constitution applies to the following, all of whom are required to adhere to it as a condition of their appointment/role within the Group: i) The Group s member practices; ii) The Group s employees; iii) Individuals working on behalf of the Group; iv) Anyone who is a member of the Group s Governing Body (including the Governing Body s Audit and Remuneration committees); v) Anyone who is a member of any other committee(s) or sub-committees established by the Group or its Governing Body. Accountable Officer: Simon Trickett 3

1. INTRODUCTION AND COMMENCEMENT 1.1. Name 1.1.1. The name of this Clinical Commissioning Group is NHS South Worcestershire Clinical Commissioning Group. 1.2. Statutory Framework 1.2.1. Clinical Commissioning Groups are established under the Health and Social Care Act 2012 ( the 2012 Act ). 1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 ( the 2006 Act ). 2 The duties of Clinical Commissioning Groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision. 3 1.2.2. The NHS Commissioning Board, which will be subsequently referred to within this constitution as NHS England, is responsible for determining applications from prospective groups to be established as Clinical Commissioning Groups 4 and undertakes an annual assessment of each established group. 5 It has powers to intervene in a Clinical Commissioning Group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so. 6 1.2.3. Clinical Commissioning Groups are clinically led membership organisations made up of general practices. The members of the Clinical Commissioning Group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. 7 1.3. Status of this Constitution 1.3.1. This constitution is made between the members of NHS South Worcestershire Clinical Commissioning Group and has effect from 18th day of January 2013 (Amended January 2018), when NHS England established the group.8 The constitution is published on the group s website at http://www.southworcsccg.nhs.uk/about-us/useful-documents/ and is available in 1 2 3 4 5 6 7 8 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act 4

hard copy on application to the Group s office at Coach House, John Comyn Drive, Worcester. 1.4. Amendment and Variation of this Constitution 1.4.1. This constitution can only be varied in two circumstances. 9 a) where the group applies to the NHS England and that application is granted; b) where in the circumstances set out in legislation the NHS England varies the group s constitution other than on application by the group. 2. AREA COVERED 2.1. The geographical area covered by NHS South Worcestershire Clinical Commissioning Group is predominantly within the geographic boundaries of Tenbury Wells, Droitwich, Worcester, Evesham and Great Malvern and Pershore. The 32 member Practices have a total registered population of just over 305,000 which is approximately 50% of the overall population of Worcestershire 2.2. Listed overleaf is the lower layer super output areas (LSOAs) the CCG area covers, as updated by NHS England as of 1st April 2017 (LSOAs are geographic areas designed to improve the reporting of small area statistics. 9 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued 5

LSOA Code 2017 LSOA Name 2017 LSOA Code 2017 LSOA Name 2017 LSOA Code 2017 LSOA Name 2017 E01032193 Malvern Hills 001A E01032332 Worcester 002D E01032325 Worcester 014C E01032212 Malvern Hills 001B E01032330 Worcester 003A E01032326 Worcester 014D E01032213 Malvern Hills 001C E01032334 Worcester 003B E01032354 Wychavon 001A E01032214 Malvern Hills 001D E01032335 Worcester 003C E01032386 Wychavon 001B E01032181 Malvern Hills 002A E01032336 Worcester 003D E01032387 Wychavon 001C E01032190 Malvern Hills 002B E01032279 Worcester 004A E01032401 Wychavon 001D E01032199 Malvern Hills 002C E01032312 Worcester 004B E01032368 Wychavon 002A E01032223 Malvern Hills 002D E01032327 Worcester 004C E01032369 Wychavon 002B E01032179 Malvern Hills 003A E01032328 Worcester 004D E01032370 Wychavon 002C E01032180 Malvern Hills 003B E01032329 Worcester 004E E01032371 Wychavon 002D E01032182 Malvern Hills 003C E01032301 Worcester 005A E01032359 Wychavon 003A E01032183 Malvern Hills 003D E01032302 Worcester 005B E01032360 Wychavon 003B E01032194 Malvern Hills 004A E01032310 Worcester 005C E01032361 Wychavon 003C E01032195 Malvern Hills 004B E01032311 Worcester 005D E01032357 Wychavon 004A E01032196 Malvern Hills 004C E01032313 Worcester 005E E01032358 Wychavon 004B E01032197 Malvern Hills 004D E01032333 Worcester 005F E01032365 Wychavon 004C E01032205 Malvern Hills 005A E01032314 Worcester 006A E01032367 Wychavon 004D E01032206 Malvern Hills 005B E01032315 Worcester 006B E01032362 Wychavon 005A E01032207 Malvern Hills 005C E01032316 Worcester 006C E01032363 Wychavon 005B E01032217 Malvern Hills 005D E01032317 Worcester 006D E01032364 Wychavon 005C E01032188 Malvern Hills 006A E01032280 Worcester 007A E01032366 Wychavon 005D E01032189 Malvern Hills 006B E01032281 Worcester 007B E01032399 Wychavon 006A E01032220 Malvern Hills 006C E01032282 Worcester 007C E01032400 Wychavon 006B E01032221 Malvern Hills 006D E01033246 Worcester 007E E01032404 Wychavon 006C E01032222 Malvern Hills 006E E01033247 Worcester 007F E01032345 Wychavon 007A E01032201 Malvern Hills 007A E01032337 Worcester 008A E01032346 Wychavon 007B E01032202 Malvern Hills 007B E01032338 Worcester 008B E01032395 Wychavon 007C E01032203 Malvern Hills 007C E01032339 Worcester 008C E01032417 Wychavon 007D E01032204 Malvern Hills 007D E01032318 Worcester 009A E01032392 Wychavon 008A E01032191 Malvern Hills 008A E01032319 Worcester 009B E01032393 Wychavon 008B E01032192 Malvern Hills 008B E01032320 Worcester 009C E01032394 Wychavon 008C E01032211 Malvern Hills 008C E01032321 Worcester 009D E01032416 Wychavon 008D E01032184 Malvern Hills 009A E01032322 Worcester 009E E01032355 Wychavon 009A E01032185 Malvern Hills 009B E01032305 Worcester 010A E01032356 Wychavon 009B E01032186 Malvern Hills 009C E01032306 Worcester 010B E01032402 Wychavon 009C E01032187 Malvern Hills 009D E01032307 Worcester 010C E01032403 Wychavon 009D E01032208 Malvern Hills 010A E01032309 Worcester 010D E01032375 Wychavon 010A E01032209 Malvern Hills 010B E01032285 Worcester 011A E01032382 Wychavon 010B E01032210 Malvern Hills 010C E01032292 Worcester 011B E01032383 Wychavon 010C E01032218 Malvern Hills 010D E01032294 Worcester 011D E01032410 Wychavon 010D E01032219 Malvern Hills 010E E01033248 Worcester 011E E01032411 Wychavon 010E E01032198 Malvern Hills 011A E01033249 Worcester 011F E01032390 Wychavon 011A E01032200 Malvern Hills 011B E01032286 Worcester 012A E01032391 Wychavon 011B E01032215 Malvern Hills 011C E01032287 Worcester 012B E01032414 Wychavon 011C E01032216 Malvern Hills 011D E01032288 Worcester 012C E01032415 Wychavon 011D E01032296 Worcester 001A E01032289 Worcester 012D E01032405 Wychavon 012A E01032297 Worcester 001B E01032290 Worcester 012E E01032406 Wychavon 012B E01032298 Worcester 001C E01032283 Worcester 013A E01032407 Wychavon 012C E01032299 Worcester 001D E01032284 Worcester 013B E01032408 Wychavon 012D E01032300 Worcester 001E E01032295 Worcester 013C E01032409 Wychavon 012E E01032303 Worcester 002A E01032308 Worcester 013D E01032340 Wychavon 013A 6

E01032304 Worcester 002B E01032323 Worcester 014A E01032341 Wychavon 013B E01032331 Worcester 002C E01032324 Worcester 014B E01032349 Wychavon 013C LSOA Code 2017 LSOA Name 2017 E01032350 Wychavon 013D E01032388 Wychavon 013E E01032389 Wychavon 013F E01032343 Wychavon 014A E01032377 Wychavon 014B E01032378 Wychavon 014C E01032376 Wychavon 015A E01032384 Wychavon 015B E01032385 Wychavon 015C E01032396 Wychavon 015D E01032342 Wychavon 016A E01032344 Wychavon 016B E01032379 Wychavon 016C E01032380 Wychavon 016D E01032381 Wychavon 017A E01032397 Wychavon 017B E01032398 Wychavon 017C E01032351 Wychavon 018A E01032352 Wychavon 018B E01032353 Wychavon 018C E01032374 Wychavon 018D E01032347 Wychavon 019A E01032348 Wychavon 019B E01032372 Wychavon 019C E01032373 Wychavon 019D E01032412 Wychavon 019E E01032413 Wychavon 019F 7

3. MEMBERSHIP 3.1. Membership of the Clinical Commissioning Group 3.1.1. The following practices comprise the members of NHS South Worcestershire Clinical Commissioning Group. Practice Name Spa Medical Practice The Corbett Medical Practice Salters Medical Practice Ombersley Medical Practice Elbury Moor Medical Centre Haresfield Surgery Barbourne Health Centre Severn Valley Medical Practice St John s House Surgery Albany House Surgery Spring Gardens Medical Practice Address The Spa Medical Practice, Droitwich Health Centre, Ombersley Street, Droitwich Spa, WR9 8RD Corbett Medical Practice, 36 Corbett Avenue, Droitwich Spa, Worcestershire, WR9 7BE Salters Medical Practice, Droitwich Medical Centre, Droitwich Spa, Worcestershire WR9 8RD Ombersley Medical Centre, Main Road, Ombersley, Worcester WR9 0EL Elbury Moor Medical Centre, Fairfield Close, Worcester, WR4 9TX Turnpike House Medical Centre, 37 Newtown Road, Worcester, WR5 1HG 44 Droitwich Road, Worcester, WR3 7LH Henwick Halt Medical Centre, 1 Ingles Drive, St John s, Worcester, WR2 5HL St John's House Surgery, 299 Bromyard Road, Worcester, WR2 5FB Albany House Surgery, Albany Terrace, Worcester WR1 3DU Spring Gardens Health Centre, 8

Practice Name St Martin s Gate Surgery Farrier House Thorneloe Lodge Surgery Upton Surgery Tenbury Wells Surgery Malvern Health Centre New Court Surgery Link End Surgery St Saviours Surgery Whiteacres Medical Centre Abbotswood Medical Centre Address Spring Gardens, Worcester WR1 2BS Dr K Solesbury and Partners, St Martin's Gate Surgery, 37 Newtown Rd, Worcester, WR5 1EZ Farrier House, Farrier Street, Worcester, WR1 3BH Thorneloe Lodge Surgery, 29 Barbourne Road, Worcester WR1 1RU Dr S M A Everitt and Partners, Upton Surgery, Tunnel Hill, Upton Upon Severn, Worcester, WR8 0QL Tenbury Wells Surgery, 34 Teme St, Tenbury Wells, Worcester, WR15 8AA Prospect View, 300 Pickersleigh Road, Malvern, WR14 2GP New Court Surgery, Prospect View, 300 Pickersleigh Road, Malvern, WR14 2GP Link End Surgery, 39 Pickersleigh Road, Malvern, Worcestershire, WR14 2RP St Saviours Surgery, Merick Road, Malvern Link WR14 1DD Whiteacres Medical Centre, Maple Road, Malvern, Worcester, WR14 1GQ Abbottswood Medical Centre, Defford Road, Pershore, 9

Practice Name Pershore Medical Practice Knightwick Surgery Great Witley Surgery De Montfort Medical Centre Abbey Medical Practice Riverside Surgery Merstow Green Medical Practice Barn Close Surgery Bredon Hill Surgery Grey Gable Surgery Address Worcestershire WR10 1HZ Pershore Medical Practice, Queen Elizabeth House, Queen Elizabeth Drive, Pershore, Worcestershire WR10 1PX The Surgery, Bromyard Rd, Knightwick, Worcester WR6 5PH The Surgery, Worcester Road, Great Witley, Nr Worcester, WR6 6HR De Montfort Medical Centre Burford Road, Evesham, Worcestershire, WR11 3HD Abbey Medical Practice, Abbey Lane, Evesham WR11 4BS Riverside Surgery, Waterside Evesham, Worcestershire WR11 1JP Merstow Green Medical Practice Abbey Lane, Evesham, WR11 4BS Barn Close Surgery, 38-40 High Street, Broadway, Worcestershire WR12 7DT Bredon Hill Surgery, Main Road, Bredon, Tewkesbury, GL20 7QN High Street Inkberrow Worcestershire WR7 4BW 10

3.1.2. Appendix B of this constitution contains the list of practices. The signatures of the practice representatives confirming their agreement to this constitution is kept at the Group s office at Coach House, John Comyn Drive, Worcester, WR3 7NS 3.2. Eligibility 3.2.1. Providers of primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of this group 10 4. MISSION, VALUES AND AIMS 4.1. Mission 4.1.1. The mission of NHS South Worcestershire Clinical Commissioning Group is: South Worcestershire CCG will be recognised as a model organisation for providing innovative and creative healthcare services for its patients. Our practices will work together to achieve goals and maximise primary care efficiency. We will use scarce resources wisely and our community will understand that unpopular decisions are taken in the best interest of the population as a whole. Ten years from now the delivery of healthcare for the residents of South Worcestershire will have improved significantly and NHS care provided will guarantee clinical quality for our patients 4.1.2. The group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. 4.2. Values 4.2.1. Good corporate governance arrangements are critical to achieving the group s objectives. 4.2.2. The values that lie at the heart of the group s work are: a) Promote a fair, ethical and transparent culture; b) Place patient safety and experience at its core; c) Identify that 'partnerships matter'; d) Listen and respond; e) Promote evidence based practice; 'right care, right place, right time'; f) Support Patient Choice matters; g) Promote privacy, dignity and mutual respect; h) Work together with member practices; i) Promote good health and wellbeing; j) Identify opportunities for service redesign and innovation; k) Ensure value for money is secured; l) Be a good employer. 10 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued 11

4.3. Aims 4.3.1. The group s aims are to: a) deliver its strategic objectives which are set at the commencement of each financial year, in line with the prevailing priorities within the health economy 4.4. Principles of Good Governance 4.4.1. In accordance with section 14L(2)(b) of the 2006 Act, 11 the group will at all times observe such generally accepted principles of good governance as are relevant to it in the way it conducts its business. These include: a) The highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business; b) The Good Governance Standard for Public Services; 12 c) The standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles 13 d) The seven key principles of the NHS Constitution; 14 e) The Equality Act 2010. 15 4.5. Accountability 4.5.1. The group will demonstrate its accountability to its members, local people, stakeholders and the NHS Commissioning Board in a number of ways, including by: a) Publishing its constitution; b) Appointing independent lay members and non GP clinicians to its Governing Body; c) Holding meetings of its Governing Body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting); d) Publishing annually a commissioning plan; 11 12 13 14 15 Inserted by section 25 of the 2012 Act The Good Governance Standard for Public Services, The Independent Commission on Good Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004 See Appendix F See Appendix G See http://www.legislation.gov.uk/ukpga/2010/15/contents 12

e) Complying with local authority health overview and scrutiny requirements; f) Meeting annually in public to publish and present its annual report (which must be published); g) Producing annual accounts in respect of each financial year which must be externally audited; h) Having a published and clear complaints process; i) Complying with the Freedom of Information Act 2000; j) Providing information to the NHS Commissioning Board as required. 4.5.2. The Governing Body of the group will throughout each year have an ongoing role in reviewing the group s governance arrangements to ensure that the group continues to reflect the principles of good governance. 5. FUNCTIONS AND GENERAL DUTIES 5.1. Functions 5.1.1. The functions that the group is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health s Functions of Clinical Commissioning Groups: a working document. They relate to: a) Commissioning certain health services (where the NHS Commissioning Board is not under a duty to do so) that meet the reasonable needs of: i) all people registered with member GP practices, and ii) people who are usually resident within the area and are not registered with a member of any Clinical Commissioning Group; b) Commissioning emergency care for anyone present in the group s area; c) Paying its employees remuneration, fees and allowances in accordance with the determinations made by its Governing Body and determining any other terms and conditions of service of the group s employees; d) Determining the remuneration and travelling or other allowances of members of its Governing Body. 5.1.2. In discharging its functions the group will: 13

a) Act, when exercising its functions to commission health services consistently 16 with the discharge by the Secretary of State and NHS England of their duty to promote a comprehensive health service 17 and with the objectives and requirements placed on the NHS Commissioning Board through the mandate 18 published by the Secretary of State before the start of each financial year by: i) Requiring progress of delivery of the duty to be monitored through the Group s reporting mechanisms, as well as delegating responsibility which is reflected within the standing orders and scheme of delegation and reservation b) meet the public sector equality duty 19 by: i) Delegation of the responsibility to oversee the discharge of this general duty to the Clinical Commissioning Group Governing Body; ii) iii) Delegation of the responsibility to publish evidence of compliance at least annually to the Accountable Officer; and Preparing and publishing specific and measurable equality objectives, revising these at least every four years. c) work in partnership with Worcestershire County Council] to develop joint strategic needs assessments 20 and joint health and wellbeing strategies 21 by: i) Membership of the Worcestershire Health and Wellbeing Board; through a nominated member and deputy to represent the Group and provide the partnership link 5.2. General Duties - in discharging its functions the group will: 5.2.1. Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements 22 by: 16 17 18 19 20 21 22 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act 14

a) Work in partnership with patients and the local community to secure the best care for them; b) Adapt engagement activities to meet the specific needs of the different patient groups and communities through the Patient and Public Involvement Advisory Group c) Publish information about health services on the Group s website and through other media d) Encourage and act on feedback 5.2.2. Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 23 by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision making, with reporting to the Governing Body as applicable, to enable review and evaluation of this function 5.2.3. Act effectively, efficiently and economically 24 by: a) Delegating lead responsibility to the Group s Governing Body b) Reporting through regular Governing Body Reports, supported by the Chief Finance Officer 5.2.4. Act with a view to securing continuous improvement to the quality of services 25 by: a) Delegating responsibility to the Chief Nurse/Director of Quality, supported through the Quality, Performance and Resources Committee 5.2.5. Assist and support NHS England in relation to the Board s duty to improve the quality of primary medical services 26 by: a) Delegating responsibility to the Group s Governing Body b) Requiring the progress of delivery of the duty to be monitored through the Governing Body reporting mechanisms 23 24 25 26 See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as amended by 2012 Act) See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 15

5.2.6. Have regard to the need to reduce inequalities 27 by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision making, with reporting to the Governing Body as applicable, to enable fulfilment of this function 5.2.7. Promote the involvement of patients, their carers and representatives in decisions about their healthcare 28 by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision making, with reporting to the Governing Body as applicable, to enable fulfilment of this function 5.2.8. Act with a view to enabling patients to make choices 29 by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision making, with reporting to the Governing Body as applicable, to enable fulfilment of this function 5.2.9. Obtain appropriate advice 30 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision making, with reporting to the Governing Body as applicable, to enable review and evaluation of this function 5.2.10. Promote innovation 31 by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision making, with reporting to the Governing Body as applicable, to enable fulfilment of this function 5.2.11. Promote research and the use of research 32 by: a) Delegating responsibility to the Governing Body and all formal committees to ensure that appropriate advice and membership is secured to support decision 27 28 29 30 31 32 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act 16

making, with reporting to the Governing Body as applicable, to enable fulfilment of this function 5.2.12. Have regard to the need to promote education and training 33 for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty 34 by: a) Delegating lead responsibility to the Accountable Officer and Chief Operating Officer to oversee the discharge of this duty 5.2.13. Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the group considers that this would improve the quality of services or reduce inequalities 35 by: a) Delegating Lead Responsibility to the Accountable Officer and Director of Strategy b) Proactively working towards the establishment and delivery of accountable care models 5.3. General Financial Duties the group will perform its functions so as to: 5.3.1. Ensure its expenditure does not exceed the aggregate of its allotments for the financial year 36 by a) Delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge b) Monitoring progress of the duty through the Group s Governing Body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 5.3.2. Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by NHS England for the financial year 37 by a) Delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge 33 34 35 36 37 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act 17

b) Monitoring progress of the duty through the Group s Governing Body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 5.3.3. Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the group does not exceed an amount specified by NHS England 38 by a) Delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge b) Monitoring progress of the duty through the Group s Governing Body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 5.3.4. Publish an explanation of how the group spent any payment in respect of quality made to it by NHS England 39 by c) Delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge d) Monitoring progress of the duty through the Group s Governing Body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 5.4. Other Relevant Regulations, Directions and Documents 5.4.1. The group will a) comply with all relevant regulations; b) comply with directions issued by the Secretary of State for Health or NHS England; and c) take account, as appropriate, of documents issued by NHS England. 5.4.2. The group will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant group policies and procedures. 38 39 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act 18

6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1 Authority to act 6.1.1 The Clinical Commissioning Group is accountable for exercising the statutory functions of the group. It may grant authority to act on its behalf to: a) any of its members; b) its Governing Body; c) employees; d) a committee or sub-committee of the group. 6.1.2 The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the group as expressed through: a) the group s scheme of reservation and delegation; and b) for committees, their terms of reference. 6.2 Scheme of Reservation and Delegation 40 6.2.1 The group s scheme of reservation and delegation sets out: a) those decisions that are reserved for the membership as a whole; b) those decisions that are the responsibilities of its Governing Body (and its committees), the group s committees and sub-committees, individual members and employees. 6.2.2 The Clinical Commissioning Group remains accountable for all of its functions, including those that it has delegated. 6.3 General 6.3.1 In discharging functions of the group that have been delegated to its Governing Body (and its committees), committees, joint committees and individuals must: a) comply with the group s principles of good governance, 41 operate in accordance with the group s scheme of reservation and delegation, 42 b) comply with the group s standing orders, 43 40 41 42 See Appendix D See section 4.4 on Principles of Good Governance above See appendix D 19

c) comply with the group s arrangements for discharging its statutory duties, 44 d) where appropriate, ensure that member practices have had the opportunity to contribute to the group s decision making process. 6.3.2 When discharging their delegated functions, committees and joint committees must also operate in accordance with their approved terms of reference. 6.3.3 Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: a) identify the roles and responsibilities of those Clinical Commissioning Groups who are working together; b) identify any pooled budgets and how these will be managed and reported in annual accounts; c) specify under which Clinical Commissioning Group s scheme of reservation and delegation and supporting policies the collaborative working arrangements will operate; d) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties; e) identify how disputes will be resolved and the steps required to terminate the working arrangements; f) specify how decisions are communicated to the collaborative partners. 6.4 Clinical Commissioning Group Practice Forum 6.4.1 The group have not established any committees, but when the members of the group meet to conduct business as the group, this will be known as the Clinical Commissioning Group Practice Forum 6.4.2 The Clinical Commissioning Group Practice Forum will be established as a group of the South Worcestershire Clinical Commissioning Group. The Practice Forum may meet in common with the Redditch and Bromsgrove and Wyre Forest Practice Forums, should any items of business arise which require an aligned, coordinated response across the Clinical Commissioning Groups. The chairs of each Practice Forum will determine whether the groups are required to meet in common and members will be notified of any such meetings being called 43 44 See appendix C See chapter 5 above 20

6.4.3 As outlined within section 2.2.2 of the standing orders, each member practice will nominate a Lead Commissioning GP as the main (but not exclusive) link for practice representation and engagement with the wider CCG membership and Governing Body. The appointment requirements are set out in Standing Orders and also included in the wider Accountability Arrangements and Agreement document for Member Practices and their individual lead commissioning representatives. 6.4.4 Any member of the Practice Forum may put themselves forward as chair, through submission of a written nomination to the Head of Corporate Governance. If more than one nomination is received, members of the Practice Forum will be required to vote and the chair selected through a simple majority 6.4.5 Quorum of the Practice Forum will require 70% of members to be in attendance, with any decisions being passed through a simple majority. Numerically, this would be 23 of 32 South Worcestershire CCG practices. Should any meetings be held in common and a vote called, 70% of members of each Practice Forum would need to be in attendance and a separate vote taken by each CCG 6.4.6 The Clinical Commissioning Group Practice Forum delegates all decision making to the Clinical Commissioning Group Governing Body with these exceptions;- a) Agreement to change the group s constitution* b) Approve the vision, values and overall strategic direction of the group c) In exceptional circumstances if a member of the group continually behaves inconsistently to the terms of reference and despite attempting to resolve the situation utilising dispute resolution process, the approval to dismiss members of the group* d) Approval of applications to be a member of the group* e) Ratify the appointment of elected members of the Clinical Commissioning Group Governing Body f) Approve the removal of elected members of the Clinical Commissioning Group Governing Body g) Approve the appointment of the Chair of the Clinical Commissioning Group Practice Forum * Subject to NHSE Approval Process 6.5 Joint Arrangements 6.5.1 The group has entered into joint arrangements with the following Clinical Commissioning Group(s): 21

a) Redditch and Bromsgrove and Wyre Forest Clinical Commissioning Groups, in terms of: i) The establishment of Governing Body meetings in common ii) The establishment of joint committees and committees in common of the Governing Body b) Herefordshire CCG, in terms of the establishment of the Herefordshire & Worcestershire Joint Commissioning Committee. 6.5.2 The group has joint committee(s) with the following local authority(ies): a) Worcestershire County Council, through the integrated Commissioning Executive Officers Group supporting the Section 75 Agreements) 6.5.3 Joint commissioning arrangements with other Clinical Commissioning Groups 6.5.3.1 The Clinical Commissioning Group (CCG) may wish to work together with other CCGs in the exercise of its commissioning functions. 6.5.3.2 The CCG may make arrangements with one or more CCG in respect of: a) delegating any of the CCG s commissioning functions to another CCG; b) exercising any of the commissioning functions of another CCG; or c) exercising jointly the commissioning functions of the CCG and another CCG 6.5.3.3 For the purposes of the arrangements described at paragraph 6.5.3.2, the CCG may: a) make payments to another CCG; b) receive payments from another CCG; c) make the services of its employees or any other resources available to another CCG; or d) receive the services of the employees or the resources available to another CCG 6.5.3.4 Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions 6.5.3.5 For the purposes of the arrangements described at paragraph 6.5.3.2 above, the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 6.5.3.2 c above. Any such pooled 22

fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made 6.5.3.6 Where the CCG makes arrangements with another CCG as described at paragraph 6.5.3.2 above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of: a) How the parties will work together to carry out their commissioning functions; b) The duties and responsibilities of the parties; c) How risk will be managed and apportioned between the parties; d) Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; e) Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements 6.5.3.7 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 6.5.3.2 above 6.5.3.8 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning 6.5.3.9 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body. 6.5.4.1 The Governing Body of the CCG shall require, in all joint commissioning arrangements, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives 6.5.4.2 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year. 6.5.4 Joint commissioning arrangements with NHS England for the exercise of CCG functions 6.5.4.3 The CCG may wish to work together with NHS England in the exercise of its commissioning functions. 6.5.4.4 The CCG and NHS England may make arrangements to exercise any of the CCG s commissioning functions jointly 23

6.5.4.5 The arrangements referred to in paragraph 6.5.4.2 above may include other CCGs 6.5.4.6 Where joint commissioning arrangements pursuant to 6.5.4.2 above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question 6.5.4.7 Arrangements made pursuant to 6.5.4.2 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG 6.5.4.8 Where the CCG makes arrangements with NHS England (and another CCG if relevant) as described at paragraph 6.5.4.2 above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of: a) How the parties will work together to carry out their commissioning functions; b) The duties and responsibilities of the parties; c) How risk will be managed and apportioned between the parties; d) Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; e) Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements; and 6.5.4.9 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 6.5.4.2 above 6.5.4.10 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning. 6.5.4.11 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body 6.5.4.12 The Governing Body of the CCG shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives 6.5.4.13 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months notice period. 24

6.5 Joint commissioning arrangements with NHS England for the exercise of NHS England s functions 6.5.5.1 The group has full delegated responsibility from NHS England for the exercise of NHS England s functions, through the establishment of a Joint Primary Care Commissioning Committee and in line with the requirements set out below 6.5.5.2 The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions 6.5.5.3 The CCG may enter into arrangements with NHS England and, where applicable, other CCGs to: a) Exercise such functions as specified by NHS England under delegated arrangements; b) Jointly exercise such functions as specified with NHS England 6.5.5.4 Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question 6.5.5.5 Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties. 6.5.5.6 For the purposes of the arrangements described at paragraph 6.5.5.3 above, NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. 6.5.5.7 Where the CCG enters into arrangements with NHS England as described at paragraph 6.5.3.3 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of: a) How the parties will work together to carry out their commissioning functions; b) The duties and responsibilities of the parties; c) How risk will be managed and apportioned between the parties; d) Financial arrangements, including payments towards a pooled fund and management of that fund; e) Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements. 25

6.5.5.8 The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into arrangements pursuant to paragraph 6.5.3b above 6.5.5.9 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning. 6.5.5.10 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body 6.5.5.11 The Governing Body of the CCG shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives. 6.5.5.12 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months notice period. 6.6 The Governing Body 6.6.1 Functions - the Governing Body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in this constitution.45 The Governing Body may also have functions of the Clinical Commissioning Group delegated to it by the group. Where the group has conferred additional functions on the Governing Body connected with its main functions, or has delegated any of the group s functions to its Governing Body, these are set out from paragraph 6.6.1(c) below. The Governing Body has responsibility for: a) ensuring that the group has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the groups principles of good governance 46 (its main function); b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the group and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act; c) The following duties and responsibilities have been agreed: i) Approving any functions of the group that are specified in regulations; 45 46 See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act See section 4.4 on Principles of Good Governance above 26

i) Leading the setting of vision and strategy; ii) iii) iv) Approving the annual commissioning plan, including consultation arrangements; Approving the annual budget; Approve distribution of total allocations received and any sums to be held in reserve v) Monitoring performance against plans and budgets; vi) vii) Providing assurance of strategic risk; Ensuring that the registers of interest are reviewed regularly, and updated as necessary; viii) Ensuring that all conflicts of interest or potential conflicts of interest are declared ix) Other responsibilities as outlined in the scheme of reservation and delegation in appendix D. 6.6.2 The Group may hold its Governing Body meetings as a meeting in common with other organisations. In the main this would be with Redditch and Bromsgrove and Wyre Forest CCGs with whom it shares a number of Governing Body roles. In these instances the role of lead Chair for the meeting will rotate between each CCG s Clinical Chair. At no time will a meeting take place if the Governing Body quoracy arrangements are not met. The holding of a meeting in common will not affect the individual terms of the CCG s Governing Bodies as set out in their constitution and the decisions of the South Worcestershire CCG Governing Body will be made and recorded appropriately. 6.6.3 Where items are pertinent to all CCGs, items will be discussed and reflected in the minutes accordingly with decisions reached being recorded respectively for each CCG 6.6.4 Where items are pertinent to one CCG only, the respective CCG Chair or deputy will take that item, lead the discussion and ensure that the decision making is reached and recorded by those Governing Body members associated to the CCG. 6.6.5 Redditch and Bromsgrove, South Worcestershire and Wyre Forest CCGs have in place collaborative working arrangements and a joint management team, and it is anticipated that in common meeting arrangements will support further alignment between the three CCGs. However, each Governing Body will continue to be accountable for its own decisions and South Worcestershire CCG may hold individual Governing Body meetings as appropriate, for example to discuss business specific to the CCG. 27